<link rel="stylesheet" href="/css/contact.css" />
<div class="concat-page">
  <div class="left"><img src="https://sp-ao.shortpixel.ai/client/to_auto,q_glossy,ret_img/https://avantdental.com.au/wp-content/uploads/2020/02/contactsection-scaled.jpg" alt="" /></div>
  <div class="right">
    <div class="title">Contact Us</div>
    <form class="form init">
      <div class="form-group">
        <span class="form-control-wrap">
          <input type="text" size="40" class="form-control" placeholder="Full Name" />
        </span>
      </div>
      <div class="form-group">
        <span class="form-control-wrap">
          <input type="email" name="email" size="40" class="form-control" placeholder="Email" />
        </span>
      </div>
      <div class="form-group">
        <span class="form-control-wrap">
          <input type="tel" name="mobile" value="" size="40" class="form-control" placeholder="Phone" />
        </span>
      </div>
      <div class="form-group">
        <span class="form-control-wrap">
          <textarea type="tel" name="mobile" value="" size="40" class="form-control" placeholder="Message"></textarea>
        </span>
      </div>
      <div class="form-group">
        <input type="submit" value="SUBMIT" class="form-control submit subscribe-btn" />
      </div>
    </form>
  </div>
</div>
